Slow Intravenous Infusion of a Novel Damage Control Cocktail Decreases Blood Loss in a Pig Polytrauma Model.

BACKGROUND: Our objective was to optimize a novel damage control resuscitation (DCR) cocktail composed of hydroxyethyl starch, vasopressin, and fibrinogen concentrate for the polytraumatized casualty. We hypothesized that slow intravenous infusion of the DCR cocktail in a pig polytrauma model would decrease internal hemorrhage and improve survival compared with bolus administration. METHODS: We induced polytrauma, including traumatic brain injury (TBI), femoral fracture, hemorrhagic shock, and free bleeding from aortic tear injury, in 18 farm pigs. The DCR cocktail consisted of 6% hydroxyethyl starch in Ringer's lactate solution (14mL/kg), vasopressin (0.8U/kg), and fibrinogen concentrate (100mg/kg) in a total fluid volume of 20mL/kg that was either divided in half and given as two boluses separated by 30 minutes as control or given as a continuous slow infusion over 60 minutes. Nine animals were studied per group and monitored for up to 3 hours. Outcomes included internal blood loss, survival, hemodynamics, lactate concentration, and organ blood flow obtained by colored microsphere injection. RESULTS: Mean internal blood loss was significantly decreased by 11.1mL/kg with infusion compared with the bolus group (p = .038). Survival to 3 hours was 80% with infusion and 40% with bolus, which was not statistically different (Kaplan Meier log-rank test, p = .17). Overall blood pressure was increased (p < .001), and blood lactate concentration was decreased (p < .001) with infusion compared with bolus. There were no differences in organ blood flow (p > .09). CONCLUSION: Controlled infusion of a novel DCR cocktail decreased hemorrhage and improved resuscitation in this polytrauma model compared with bolus. The rate of infusion of intravenous fluids should be considered as an important aspect of DCR.

Association of Sepsis Mortality with Specific Cancer Sites and Treatment Type: The Multiethnic Cohort Study.

Sepsis is a severe dysregulated immune response to infection. Sepsis deaths represent 9% of cancer deaths in the U.S. Evidence of the effect of specific cancer sites on sepsis mortality risk remains limited, and no research has evaluated the effect of cancer treatment on the risk of sepsis death. We examined whether cancer sites and treatments differentially affect the risk of sepsis death compared to other-cause mortality, among the 94,784 Hawaii participants in the Multiethnic Cohort, including 29,255 cancer cases, using competing risk Cox proportional hazards regression. Cancer diagnosis at any site was associated with similar increases in sepsis and non-sepsis mortality risk (HR: 3.39 and 3.51, resp.). Colorectal cancer differentially affected the risk of sepsis and non-sepsis mortality with a 40% higher effect on the risk of sepsis death compared with non-sepsis mortality (RRR: 1.40; 95% CI: 1.14-1.72). Lung cancer was associated with a significantly lower increase in sepsis compared to non-sepsis mortality (HR: 1.22 and 3.0, resp.; RRR: 0.39). Radiation therapy had no effect on sepsis mortality but was associated with higher risk of non-sepsis mortality (HR: 0.90 and 1.16, resp.; RRR: 0.76), whereas chemotherapy was associated with higher risk of both sepsis and non-sepsis mortality (HR: 1.31 and 1.21, resp.). We conclude that the risk of sepsis-related mortality is differentially affected by cancer sites and treatments. These associations were consistent across sexes and ethnic groups.

Comparative Analysis of Metabolic Syndrome Diagnostic Criteria and Its Effects on Prevalence in a Multiethnic Population.

Background: Accurate prevalence measurement and diagnosis to prevent type 2 diabetes mellitus and cardiovascular disease cannot occur without consistent diagnostic criteria that can be applied to varying populations. Objective: The objective of this study was to determine the prevalence of metabolic syndrome in Caucasian, Filipino, Native Hawaiian, and Japanese populations utilizing different definitions. Methods: This study utilized cross-sectional study data from the Native Hawaiian/Multiethnic Health Research Project, collected from a population living in Kohala, Hawai'i. The National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPII), International Diabetes Federation (IDF), and World Health Organization (WHO) definitions were utilized, and each of the 1452 participants were evaluated on the criteria for metabolic syndrome based on all three definitions. Additionally, the average biomarker values associated with the diagnosis were taken for each ethnic group represented in the study and compared with Caucasians. Results: The overall prevalence of metabolic syndrome in this population varied from 22.31% to 39.05% using the different definitions. Ethnic disparities also occur, implying that certain populations are more prone to having severe abnormalities than others-shown when comparing the average biomarker values associated with metabolic syndrome diagnosis. Of all ethnic groups included in the study, Caucasians had the lowest prevalence of metabolic syndrome, while part-Hawaiians had the highest prevalence. Additionally, within the same ethnic group, the definitions yielded varying prevalence values. Conclusions: This implies that discrepancies exist among the criteria alone. Implications of this study revolve around not only the correct definition to apply to the population being studied but also the most accurate way to detect certain biomarker abnormalities to accurately assess the prevalence of metabolic syndrome in a multiethnic population.